Pulmonology Coding Alert

Question: A 40-year-old patient visited our clinic for their annual flu vaccine. During the visit, the patient requested to receive their bivalent COVID-19 vaccine booster, as they hadn’t received the booster yet. The provider administered a 0.5 mL ccIIV4 flu vaccine and a 0.3 mL bivalent COVID-19 vaccine during the same encounter. Both vaccines were administered intramuscularly.

Would I report 90471 and +90472 for the flu vaccine adminis­tration and COVID-19 vaccine administration?

Nebraska Subscriber

Answer: Since the provider administered a flu vaccine and a COVID-19 vaccine during the same encounter, you’ll assign the following codes:

Flu vaccine: 90471 (Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)) and 90674 (Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use)

COVID-19 vaccine: 91312 (Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use) and 0124A (Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation, booster dose)

While reporting 90471 and +90472 (… each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)) for the administration of two vaccines may be tempting, the second code is incorrect because COVID-19 vaccine administration has separate reporting rules.

According to the AMA’s COVID-19 CPT^® Coding and Guidance, each COVID-19 vaccine code has a corresponding administration code (www.ama-assn.org/find-covid-19- vaccine-codes). At the same time, a parenthetical note is listed under each COVID-19 vaccine code in the AMA CPT^® code set that instructs you to report the vaccine code with its corresponding administration code.

Show medical necessity: Don’t forget to include the appropriate diagnosis codes to explain the medical necessity for the encounter. For your situation, you’ll assign Z23 (Encounter for immunization).